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2004 State Estimates of Substance Use
(from the 2003-2004 National Surveys on Drug Use & Health)

bulletNational data      bulletState level data       bulletMetropolitan and other subState area data

5. Substance Dependence, Abuse, and Treatment Need

The National Survey on Drug Use and Health (NSDUH) includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, and inhalants, and nonmedical use of prescription-type drugs. These questions are used to classify persons as dependent or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about health and emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use. Dependence reflects a more severe substance problem than abuse, and persons are classified with abuse of a particular substance only if they are not dependent on that substance.

An estimated 22.0 million persons aged 12 or older in 2003-2004 were classified with dependence on or abuse of any illicit drug or alcohol in the past year. Of these, 7.1 million were dependent on or had abused illicit drugs, and 18.2 million were dependent on or had abused alcohol (see Tables 16, 18, and 20, http://www.oas.samhsa.gov/2k4State/Vars.htm).

5.1 Alcohol Dependence or Abuse

Nationally in 2003-2004, 7.6 percent of the population aged 12 or older was classified with dependence on or abuse of alcohol in the past year (Table  B.16). Persons aged 18 to 25 had the highest rate of alcohol dependence or abuse (17.3 percent) in the Nation. Wisconsin had the highest rate (11.3 percent) among persons aged 12 or older. Alabama and North Carolina shared the lowest rate among States (6.0 percent). Five States (Montana, New Mexico, South Dakota, Wisconsin, and Wyoming) ranked in the highest fifth for all three age groups (12 to 17, 18 to 25, 26 or older) and among all persons 12 or older (Figures 5.1 to 5.4).

Past year dependence on or abuse of alcohol remained unchanged between 2002-2003 and 2003-2004 at 7.6 percent of all persons aged 12 or older (Table  C.16). However, the rate among youths aged 12 to 17 increased significantly in the West during the same period, from 6.0 to 6.6 percent, while the rate among young adults aged 18 to 25 decreased significantly in the South, from 16.4 to 15.5 percent. Among all persons aged 12 or older, only three States showed significant changes. Georgia and Michigan had declines in past year alcohol dependence or abuse, from 7.4 to 6.1 percent and from 8.5 to 7.6 percent, respectively. In Wisconsin, the rate increased from 9.5 to 11.3 percent.

In 2003-2004, 3.3 percent of persons aged 12 or older were estimated to be dependent on alcohol in the past year, representing about 44 percent of those who were dependent on or had abused alcohol in the past year (Table s B.16 and B.17). State estimates for alcohol dependence for persons aged 12 or older ranged from 2.7 percent in New Jersey to 5.0 percent in the District of Columbia. The highest rates for alcohol dependence occurred in the 18 to 25 age group. About 7 percent of young adults were dependent on alcohol in the past year. Seven States that ranked in the highest fifth in the 12 or older population for dependence on or abuse of alcohol in the past year also were ranked in the highest fifth for past year alcohol dependence (Figures 5.1 and 5.5). Among persons aged 12 or older, Michigan was the only State that had a change, a decrease in the past year alcohol dependence rate from 3.8 percent in 2002-2003 to 3.2 percent in 2003-2004 (Table  C.17). This decrease was fueled largely by a decrease among persons aged 26 or older.

5.2 Illicit Drug Dependence or Abuse

Nationally in 2003-2004, about 3.0 percent of persons aged 12 or older were dependent on or had abused illicit drugs in the past year (Table  B.18). New Mexico had the highest rate of past year illicit drug dependence or abuse (3.7 percent) among persons aged 12 or older, and South Dakota had the lowest rate (2.5 percent). The highest rates for past year illicit drug dependence or abuse occurred in the 18 to 25 age group, with Massachusetts having the highest rate (11.1 percent). There was no change in the rates of past year illicit drug dependence or abuse between 2002-2003 and 2003-2004 either nationally or in any region for any age group (Table  C.18). Vermont was the only State with a significant change, a decrease among youths aged 12 to 17 from 7.9 to 6.0 percent over the time period.

The percentage of persons in 2003-2004 estimated to be dependent on illicit drugs in the past year was 1.9 percent (about 65 percent of those who were estimated to be dependent on or had abused illicit drugs in the past year) (Table s B.18 and B.19). The District of Columbia had the highest percentage of persons who were dependent on illicit drugs in the past year among those aged 12 or older (2.5 percent). Nationally, there was no change in the rate of past year dependence on illicit drugs between 2002-2003 and 2003-2004 in any of the age groups (Table  C.19).

There was a slight relationship in 2003-2004 between the high rates of past year illicit drug dependence and the high rates of past year cocaine use for persons aged 12 or older at the State level. Five States ranked in the highest fifth for both measures (Figures 2.24 and 5.13). The relationship between low rates of past year illicit drug dependence and low rates of past year cocaine use for persons aged 12 or older at the State level was the same. Five States ranked in the lowest quintile for both measures.

5.3 Alcohol or Illicit Drug Dependence or Abuse

The national rate in 2003-2004 for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older was about 9.2 percent (Table  B.20). When examining dependence on or abuse of alcohol or illicit drugs at the State level, the States with high rates for alcohol dependence or abuse tended to rank in the top fifth for alcohol and illicit drug dependence or abuse combined because alcohol accounts for most substance dependence or abuse. Nine States that ranked in the highest fifth for past year alcohol dependence or abuse also ranked in the top fifth for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older (Arizona, District of Columbia, Montana, New Mexico, North Dakota, Rhode Island, South Dakota, Wisconsin, and Wyoming) (Figures 5.1 and 5.17).

State percentages for past year dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older ranged from a low of 7.4 percent in Alabama to a high of 12.2 percent in Wisconsin (Table  B.20). Only two States, New Mexico and Wisconsin, were in the highest fifth for all three age groups (12 to 17, 18 to 25, and 26 or older) (Figures 5.18 to 5.20).

Among all persons aged 12 or older, the rate of past year dependence on or abuse of alcohol or illicit drugs remained stationary at 9.2 percent in 2002-2003 and 2003-2004 (Table  C.20). The only significant regional change occurred in the South among young adults aged 18 to 25, a slight decrease from 20.2 to 19.3 percent.

5.4 Needing But Not Receiving Treatment for Illicit Drug Problems

The definition of a person needing but not receiving treatment for an illicit drug problem is that the person meets the criteria for abuse of or dependence on illicit drugs according to the DSM-IV, but has not received specialty treatment for an illicit drug problem in the past year. Specialty treatment is treatment received at a drug and alcohol rehabilitation facility (inpatient or outpatient), hospital (inpatient only), or mental health center.

In 2003-2004, Alaska had the highest percentage of persons aged 12 or older needing but not receiving treatment for an illicit drug use problem (3.5 percent), while South Dakota had the lowest rate (2.2 percent) (Table  B.21). The States in the top fifth for needing but not receiving treatment for an illicit drug use problem among persons 12 or older were mainly in the West (five States) or in the Northeast (four States). New Mexico was the only State in the top fifth for persons aged 12 to 17, 18 to 25, and 26 or older (Figures 5.21 to 5.24).

Vermont was the only State that had any significant change in the percentage of persons needing but not receiving treatment for illicit drug problems, either in the total population of persons aged 12 or older or in any of the component age groups between 2002-2003 and 2003-2004. Vermont had a decrease among the percentage of youths aged 12 to 17 needing but not receiving treatment for an illicit drug use problem from 7.2 to 5.6 percent (Table  C.21).

5.5 Needing But Not Receiving Treatment for Alcohol Problems

The definition of a person needing but not receiving treatment for an alcohol problem is that the person meets the criteria for abuse of or dependence on alcohol according to the DSM-IV, but has not received specialty treatment for an alcohol problem in the past year. The percentage of persons aged 12 or older needing but not receiving treatment for alcohol problems (7.3 percent) in 2003-2004 was almost 3 times larger than the corresponding percentage for persons needing but not receiving treatment for illicit drug problems (2.7 percent) (Table s B.21 and B.22).

States in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older were primarily Western (five States) or Midwestern (three States) (Figure 5.25). Colorado, New Mexico, and Rhode Island were ranked in the highest quintile for both needing but not receiving treatment for an alcohol problem and needing but not receiving treatment for an illicit drug problem among persons aged 12 or older (Figures 5.21 and 5.25). Four States were ranked in the top fifth for needing but not receiving treatment for alcohol problems among persons aged 12 or older in each of the three age categories (12 to 17, 18 to 25, and 26 or older): Montana, New Mexico, Wisconsin, and Wyoming (Figures 5.25 to 5.28). Wisconsin had the highest rate of needing but not receiving treatment for an alcohol problem (10.8 percent) (Table  B.22). Alabama and North Carolina were tied for the lowest rate (5.6 percent).

Among persons aged 12 or older, there were no significant changes between 2002-2003 and 2003-2004 for the Nation as a whole or for any of the four regions in the percentage needing but not receiving treatment for alcohol in the past year (Table  C.22). However, three States showed significant changes. Georgia and Michigan both had decreases (from 7.1 to 5.9 percent and from 8.1 to 7.2 percent, respectively). Wisconsin, however, showed an increase during this period, from 8.9 to 10.8 percent, mainly fueled by an increase among the 26 or older age group.

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Figure 5.1 Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.1

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.2 Alcohol Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.2

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.3 Alcohol Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.3

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.4 Alcohol Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.4

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.5 Alcohol Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.5

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.6 Alcohol Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.6

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.7 Alcohol Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.7

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.8 Alcohol Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.8

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.9 Any Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs

Figure 5.9

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.10 Any Illicit Drug Dependence or Abuse in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.10

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.11 Any Illicit Drug Dependence or Abuse in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.11

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.12 Any Illicit Drug Dependence or Abuse in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.12

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.13 Any Illicit Drug Dependence in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.13

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.14 Any Illicit Drug Dependence in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.14

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.15 Any Illicit Drug Dependence in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.15

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.16 Any Illicit Drug Dependence in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.16

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.17 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.17

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.18 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.18

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.19 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.19

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.20 Dependence on or Abuse of Any Illicit Drug or Alcohol in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.20

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.21 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.21

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.22 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.22

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.23 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.23

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.24 Needing But Not Receiving Treatment for Illicit Drug Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.24

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.25 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.25

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.26 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.26

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.27 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.27

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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Figure 5.28 Needing But Not Receiving Treatment for Alcohol Use in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2003 and 2004 NSDUHs

Figure 5.28

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2003 and 2004.

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This page was last updated on December 30, 2008.